The AAFP is criticizing a provision in the Obama administration's 2014 fiscal year budget proposal(www.hhs.gov) that would enact across-the-board cuts in graduate medical education (GME) for teaching hospitals, but the Academy found other things to support in the budget.

HHS Secretary Kathleen Sebelius makes a point about the president's 2014 fiscal year budget during an April 10 HHS press conference.

In a prepared statement, AAFP Board Chair Glen Stream, M.D., M.B.I., of Spokane, Wash., said that GME cuts would "jeopardize family medicine residency programs at a time when they require critical investment to sustain the growing interest in training primary care physicians."

"The evidence shows that improving quality and reining in costs depend on a strong primary care foundation," said Stream. "We have just begun to see a turnaround in the number of students looking for family medicine residency training, but without adequate support for training these physicians, that turnaround could quickly fade."

According to Stream, when faced with limits on training funding, academic teaching centers often have chosen to close primary care training residencies. For example, between 2003 and 2013, the American medical education system closed 71 family medicine programs, said Stream. "The trend reversed last year, when no family medicine programs closed and seven new family medicine residency programs were accredited. A blanket cut to GME could reverse that progress."

The Obama administration's 2014 budget proposal also addresses Medicare physician payment by assuming a 10-year fix to the sustainable growth rate (SGR) formula, which has called for steep reductions in the Medicare physician payment rate during past several years. In his statement, Stream reiterated the AAFP's call for an outright repeal of the SGR and a period of stable Medicare payments that would include higher payment rates for primary care as Medicare transitions to a system based on value instead of volume.

Stream praised other parts of the president's budget, as well. For example, enactment of a proposal to increase taxes on tobacco products would decrease tobacco use, especially among teenagers and young adults, according to Stream.

Stream also was pleased that the budget calls for implementing provisions in the health care reform law that "improve access to care for low-income working families, that reward quality of care through the patient-centered medical home, and that provide health security to the elderly and disabled."